Evaluating the Role of a Medical Home Model in the Successful Management of Diabe

描述(由申请人提供)：在初级保健医生如何为患者提供护理方面，有可能减少弱势成年人在2型糖尿病(以下称为糖尿病)预后方面的差异。虽然提供者可以提供良好的技术护理质量(即所提供的临床服务和提出的治疗建议)，但在提供者如何使患者获得这些服务、如何就复杂的管理方案与患者进行良好的双向沟通以及如何协调护理与其他照顾患者病情的提供者方面存在已知的不足。对于弱势成年人--种族/族裔少数群体、社会经济地位较低的人和依赖国家安全网医疗保健系统的人--来说，这些缺陷尤其严重，并可能导致糖尿病结果的差异。拟议研究的目标是了解向成人糖尿病患者提供初级保健服务的方式是否影响患者最终接受的临床服务，以及患者遵守提供者的建议以成功管理其病情的情况。我们认为，而且有大量证据表明，按照“医疗之家模式”提供护理有助于改善患者体验，并可能改善患者对适当护理的接受和反应。医疗院应该随处可见，促进与患者的持续关系，包括有效的双向沟通，提供全面的服务，在需要时帮助协调服务，并始终考虑到家庭背景和文化背景。‘具体目标1：检验以下假设：更好的疗养院表现会增加推荐的糖尿病护理的接受率，改善与更好地管理病情相关的患者生理指标，并减少不利的卫生保健利用。‘具体目标2：探讨提供初级保健的实践环境(即社区卫生中心、团体实践和单独实践)是否影响医生的医疗家庭表现，从而影响患者对糖尿病护理的反应。 公共卫生相关性：拟议的研究将提供关于提供初级卫生保健的不同方法的关键信息，这些方法可以改善弱势成年人的成功护理和糖尿病结果。在糖尿病发病率处于流行水平的情况下，结果将有助于了解如何最好地提高质量，减少糖尿病管理和结果方面的差距。

DESCRIPTION (provided by applicant): in how primary care physicians deliver care to their patients are likely to reduce disparities in Type 2 diabetes (hereafter referred to as diabetes) outcomes for vulnerable adults. While providers may offer good technical quality of care (i.e., the clinical services provided and therapeutic recommendations made), there are known deficits in how providers make those services accessible to patients, how well two-way communication occurs with patients about complex management regimens, and how care is coordinated with other providers caring for the patients' condition. These deficits are particularly acute for vulnerable adults-racial/ethnic minorities, those with low socioeconomic status and those who rely on the nation's safety net health care system-and are likely to contribute to disparities in diabetes outcomes. The goal of the proposed research is to understand whether the way in which primary care services are delivered to diabetic adults influences what clinical services are ultimately received by patients and how well patients adhere to providers' recommendations to successfully manage their condition. We think, and there is a body of evidence to suggest, that delivering care in accordance with a "medical home model" helps to improve patient experiences and may improve patients' receipt of, and response to, appropriate care. A medical home should be widely accessible, facilitate a continuous relationship with patients including effective two-way communication, provide comprehensive services, help to coordinate services when needed, and account for family context and cultural background throughout. ' Specific Objective 1: To test the hypothesis that better medical home performance increases the receipt of recommended diabetes care, improves patient physiologic measures associated with better management of the condition, and reduces adverse health care utilization. ' Specific Objective 2: To explore whether the practice setting in which primary care is delivered (i.e., community health centers, group practices, and solo practices) affects the medical home performance of physicians and, as a result, the response of patients to diabetes care. PUBLIC HEALTH RELEVANCE: The proposed research will provide critical information about different approaches to delivering primary health care that can improve the successful care and outcomes of diabetes among vulnerable adults. With rates of diabetes at epidemic levels, the results will help inform how to best improve quality and reduce disparities in diabetes management and outcomes.